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Ayer — Octubre 2nd 2025Tus fuentes RSS

Efficacy of a mobile app-based intervention to improve eating behaviours and lifestyle in infants of mothers with metabolic risk factors: study protocol of a randomised controlled trial

Por: Chan · D. · Leong · K. · Ong · C. · Ku · C. W. · Chan · J. K. Y. · Chua · M. C. · Yap · F. · Loy · S. L.
Introduction

Childhood obesity has surged globally, leading to various metabolic comorbidities and increased cardiovascular risks. Early intervention in lifestyle and feeding practices during infancy is crucial to mitigate these risks. This study evaluates the efficacy of a mobile web app-based intervention tool, named the Feeding, Lifestyle, Activity Goals (FLAGs) to promote healthier eating behaviours and lifestyle habits in infants from birth to 12 months.

Methods and analysis

This two-arm randomised controlled trial will enrol 220 caregiver-infant pairs per arm at KK Women’s and Children’s Hospital, Singapore, with recruitment expected from January to December 2025. Eligible participants include women at ≥34 weeks’ gestation or up to 3 days post delivery with pre-pregnancy overweight/obesity (body mass index (BMI) >23 kg/m2) and/or a diagnosis of diabetes. Caregiver-infant pairs will be randomised to the FLAGs intervention or control group. Over 12 months, both groups will receive standard infant care. The intervention group will undergo regular assessments via the FLAGs web app built-in assessment tool, assessing infant feeding practices, sedentary behaviour and physical activity. The intervention group will also receive FLAGs personalised guidance and weekly digital nudges. Maternal and infant data will be collected at baseline and at 12 months. Primary outcomes are infant BMI, weight-for-length and body composition at 12 months. Secondary outcomes include lifestyle behaviours and eating habits assessed through validated questionnaires when the infants are 1 year old. We will perform both intention-to-treat and per protocol analysis.

Ethics and dissemination

Ethical approval has been obtained from the SingHealth Centralised Institutional Review Board (Ref: 2024/3224). Written informed consent will be obtained from all participants. Study findings will be disseminated via peer-reviewed publications and academic conferences, with de-identified data available on reasonable request. This trial is registered on ClinicalTrials.gov (ID: NCT06457750).

Trial registration number

NCT06457750.

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Grief, Uncertainty and Community: A Qualitative Study on Parental Experiences of Paediatric Feeding Disorders and Feeding Tube Use in Singapore

ABSTRACT

Aim

To explore the perceptions and experiences of parents caring for children with paediatric feeding disorders requiring feeding tubes (PFD-T).

Study Design

A descriptive qualitative approach was adopted in this study.

Methods

Using purposive sampling, 12 parents were recruited from paediatric inpatient wards and the outpatient paediatric feeding clinic at a tertiary public hospital in Singapore. Data collection was done from July to December 2024. Semi-structured one-on-one interviews were conducted with the parents (fathers or mothers) until data saturation. Thematic analysis was used to identify themes from the interview content.

Results

A total of three themes and six subthemes were identified, encapsulating the challenges experienced by parents with caregiving and feeding tube management, as well as the sources of support they had. The themes are: (1) A sense of community, (2) Grieving over the loss of normalcy and (3) Facing the unknown.

Conclusion

Parents in this study felt supported being in a community of other parents with children who have PFD-T. It enabled them to gain valuable information and offered them a space where they felt understood. At the same time, they expressed feelings of guilt and isolation, as the caregiving demands led to limited capacity to cater to or interact with other loved ones. Additional challenges parents faced included transitioning between types of feeding tubes and insufficient support from healthcare professionals.

Trial and Protocol Registration

Ethical approval was obtained from the National Health Group Domain Specific Review Board (DSRB 2024/00064) on 8 May 2024.

Reporting Method

This study followed the reporting guidelines outlined by the COnsolidated criteria for REporting Qualitative (COREQ) research checklist.

Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Longitudinal Analysis of Mental Health Trajectories in Lung Cancer Survivors: A Hierarchical Linear Modelling Approach

ABSTRACT

Aims

To examine individual variations in mental health trajectories and identify associated risk factors among patients with lung cancer.

Design

A longitudinal study.

Methods

Participants recruited from outpatient clinics at five time points: 1, 3, 6, 9 and 12 months after a diagnosis. Data collected included demographic and disease-related characteristics, symptom distress, and mental health. Hierarchical Linear Modelling (HLM) was used to analyse changes in mental health trajectories and identify significant predictors. The study is reported using the STROBE checklist.

Results

In total, 130 patients with lung cancer were included in the study. Mental health demonstrated a significant improvement over time, with notable individual variations in patterns of improvement. Male patients and those experiencing high levels of symptom distress exhibited slower improvements in mental health over time.

Conclusions

Patients with lung cancer showed overall improvement in mental health within 1 year following a diagnosis; however, the pattern of improvement varied among individuals. Male patients and those with high levels of symptom distress constituted a vulnerable group, exhibiting poorer mental health outcomes over time.

Implications for the Profession and Patient Care

Early assessments of and individualised interventions for symptoms distress to improve mental health should be considered essential components of care to enhance the overall well-being of patients with lung cancer.

Impact

These findings highlight the need for healthcare professionals implementing person-centred interventions aimed at improving mental health that might be beneficial for patients with lung cancer.

Reporting Method

Study methods and results reported in adherence to the STROBE checklist.

Patient or Public Contribution

Patients contributed their consent, time, and data to the study.

Parents' Lived Experiences of Their Child's Undergoing Emergence Delirium During Anaesthesia Recovery: A Descriptive Phenomenological Study

ABSTRACT

Aim

To explore parents' experience when their children underwent emergence delirium during anaesthesia recovery.

Design

A descriptive phenomenological qualitative study.

Methods and Setting

This descriptive phenomenological study was conducted at a medical center in Taiwan. Purposive sampling was employed, and a semi-structured interview guide was used to conduct in-depth interviews. Twelve parents whose children experienced emergence delirium were recruited after data saturation was reached. Data were collected between January and July 2024 and analysed using Colaizzi's seven-step method.

Findings

Parents underwent an unexpected journey characterised by emotional ups and downs when witnessing their child's emergence delirium. Four major themes were generated, including ‘unexpected chaos’, describing the disorienting situation parents experienced when confronted with their child's unfamiliar behaviours; ‘help beyond reach’, reflecting their inability to provide comfort despite being physically present; ‘a day of suffering’, highlighting the emotional overwhelm during the emergence delirium episode; and ‘appreciation after recovery’, illustrating their relief and gratitude once their child returned to baseline. These themes reveal the intense emotional fluctuations parents experience during this critical phase.

Conclusions

This study highlights the complex emotional fluctuations parents experience when facing their child's emergence delirium. The findings emphasise the need for anticipatory guidance and support strategies to better prepare parents and inform family-centred nursing practices.

Impact

This study addresses a gap regarding the emotional challenges experienced by East Asian parents when their child undergoes emergence delirium. The findings reveal complex parental distress shaped by internal worry and external social pressure in shared recovery spaces. These insights inform culturally sensitive care models, emphasising the importance of private environments and communication strategies that reduce parental stress and improve clinical support.

Patient or Public Contribution

Two parents reviewed and provided feedback on the interview content and results, improving cultural relevance and clarity.

Reporting Method

The study followed COREQ guidelines.

Exploring prehospital emergency care challenges and interventions to reduce emergency department overcrowding: a qualitative meta-synthesis

Por: Chua · E. · Ji · S. · Kok · H. W. · Lai · Y. F. · Chua · C.
Background

Challenges within prehospital emergency care (PEC) have significant implications for the provision of emergency department (ED) care. However, ED overcrowding is a prevalent issue with negative impacts on patient outcomes. It can be attributed to multiple factors, such as non-emergency attendances, inaccessible alternative care service pathways (ACSPs) and inefficiencies in emergency medical service operations. ED overcrowding has prompted healthcare systems worldwide to implement interventions. These include tele-triaging, virtual ED and non-conveyance protocols that primarily aim to reduce demand for ED care and increase the supply of alternative services. However, despite such efforts, there remain unaddressed limitations that prevent PEC interventions from being successfully implemented. Moreover, prior studies and reviews have found mixed results, and that ED overcrowding interventions remain underused. Therefore, there is a need for this qualitative systematic review and meta-synthesis to capture the complexities of implementation challenges and identify enablers required to complement PEC interventions.

Objectives

This systematic review and meta-synthesis aims to offer a consolidated overview of PEC interventions intended to reduce ED overcrowding. It focuses on presenting international perspectives on the current challenges these interventions face. The enablers presented in this review could also better inform the actions taken by healthcare systems aiming to implement similar interventions.

Methods

A comprehensive search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature Complete, PsycINFO, Web of Science and Scopus was conducted to obtain a set of qualitative studies. Following a quality appraisal with the Critical Appraisal Skills Programme tool, data from the included studies were extracted and meta-synthesised.

Results

A final 21 qualitative intervention-based studies were included. Through these studies, four themes were identified: (1) types of PEC interventions to alleviate ED demands and right-site patients, (2) perceived benefits of interventions, (3) challenges in implementing interventions and (4) key enablers for successful implementation of interventions. Our results describe key factors such as the importance of ACSPs and support for PEC healthcare workers in the form of standardised guidelines, as well as education and training.

Conclusion

We further discuss how enablers can integrate into current PEC systems to complement the interventions explored. Discussions are concentrated on several key interventions (tele-triaging, virtual ED and non-conveyance protocols) as they were perceived to hold significant potential in addressing PEC challenges and could be further elevated through various enablers. Overall, we could conclude that each intervention needs to be complemented by enablers to optimise its benefits.

Perceptions of Nurses and Nursing Students Regarding Evidence‐Based Nursing: A Qualitative Systematic Review

ABSTRACT

Aim

To consolidate and synthesise the literature reporting perceptions of nurses and nursing students regarding evidence-based nursing.

Design

Qualitative systematic review.

Data Sources

Seven electronic databases (Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest Dissertations & Theses Global, PsycInfo, PubMed, Scopus and Web of Science) were searched from their respective inception dates to January 2025.

Methods

The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines guided this review. The quality of included studies was assessed using the Critical Appraisal Skills Programme tool, and data were synthesised thematically using Sandelowski and Barroso's two-step approach.

Results

Thematic analysis of the 19 included studies, published from 2007 to 2025, identified three key themes: (1) Advancing nursing through evidence, (2) Personal, structural and systemic challenges and (3) Promoting a new evidence-based nursing culture.

Conclusion

Evidence-based nursing can elevate nursing care standards and enhance patient outcomes. Numerous factors that encourage and hinder the implementation of evidence-based nursing among nurses and nursing students were reported.

Implications for the Profession and/or Patient Care

This review suggests the need to incentivise nurses to champion evidence-based nursing initiatives, provide nurses and nursing students with continuing education, and develop updated evidence-based nursing guidelines. These strategies could help in cultivating a supportive evidence-based nursing workplace culture and improving the implementation of evidence-based nursing.

Impact

Valuable insights into the facilitators and barriers associated with the implementation of evidence-based nursing were reported by nurses and nursing students—the key personnel responsible for practising evidence-based nursing. Future research could be undertaken to explore the perceptions of nurses and nursing students across varied cultural settings and in underrepresented regions.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct, or reporting.

Skin evaluation of turmeric/epigallocatechin-3-gallate emulgel for skin irritation and sensitisation effects in healthy Thai participants (TULIP): a protocol for a randomised, double-blind, placebo-controlled trial

Por: Yeerong · K. · Ampasavate · C. · Rayanakorn · A. · Chuamanochan · M. · Tovanabutra · N. · Na Takuathung · M. · Koonrungsesomboon · N.
Background

Evaluating skin reactions is crucial in topical product development. Turmeric/epigallocatechin-3-gallate (EGCG) emulgel demonstrates therapeutic potential for cutaneous diseases, warranting further investigation in human studies. The Human Repeat Insult Patch Test (HRIPT) of skin irritation and sensitisation potential caused by the turmeric/EGCG emulgel is designed to evaluate the safety of the investigational product in healthy volunteers prior to conducting the efficacy study in patients with dermatological diseases.

Methods and analysis

60 healthy Thai volunteers will be enrolled in this single-centre, double-blind HRIPT pilot clinical trial to evaluate skin irritation and sensitisation potential caused by turmeric/EGCG emulgel. Primary endpoints include the number and proportion of participants exhibiting skin irritation and sensitisation, while secondary endpoints focus on the frequency and severity of adverse events. The study will comprise a screening period, a 3-week induction phase, a 2-week rest phase and a 1-week challenge phase. Fully occlusive adhesive patches containing study products will be applied to participants’ backs 10 times. Skin irritation will be assessed using the Draize dermal irritation scoring system, and skin sensitisation will be evaluated using the International Contact Dermatitis Research Group scoring system.

Ethics and dissemination

The Research Ethics Committee of the Faculty of Medicine, Chiang Mai University, approved this study protocol and related documents on 6 March 2025 (Ref. No. 108/2025).

Trial registration number

TCTR20250317007.

Protocol for a double-blinded randomised controlled trial and process evaluation of a digital psychotherapeutic app in Singapore to improve symptom burden in patients with dermatological problems

Por: Choi · E. · Long · V. · Phan · P. · Shen · L. · Lim · Z. V. · Koh · M. J.-A. · Chua · J. Y. · Dalakoti · M. · Ho · C. S. · Chandran · N. S. · Sevdalis · N. · Valderas · J. M. · Hsu · K. J.
Introduction

Chronic inflammatory skin diseases, despite low mortality, significantly impair quality of life (QoL). Up to 80% of patients with dermatological conditions experience severe itch and poor sleep, as well as related mental health challenges such as anxiety and depression. The relationship between skin diseases and mental health highlights the challenges that doctors face in treating these conditions. Existing psychotherapeutics, such as mindfulness training, cognitive behavioural therapy and acceptance and commitment therapy, are widely used and effective in the treatment of mental health illnesses. However, there is limited evidence on the application of such interventions in dermatology, and most mental health apps lack robust clinical evaluation. We report the design of a randomised controlled trial to evaluate the efficacy and implementation of a mobile app containing dermatology-specified psychotherapeutic strategies in reducing QoL burden.

Methods and analysis

English-speaking patients aged 16 years and older with psoriasis, eczema or chronic urticaria will be recruited and randomised into the intervention arm (psychotherapeutic application) or active control group (Healthy365 app, a general wellness application managed by the Singapore Health Promotion Board). This allows a comparative assessment of app-usage-specific outcomes while preserving the blinding of all participants. The primary outcome is the change in the Dermatology Life Quality Index (DLQI) score from baseline to week 8. Secondary outcomes include physician-assessed disease severity at weeks 8 and 16 relative to baseline, differences in other patient-reported measures at weeks 8, 16 and 32, self-reported treatment adherence and initiation/escalation of systemic medications. To understand how patients engage with the app, we will evaluate the implementation process, focusing on key measures such as engagement, satisfaction and willingness to pay. Statistical analysis will be carried out on an intention-to-treat basis, and missing data will be analysed using last observation carried forward.

All participants will receive both verbal and written study information that aligns with Good Clinical Practice guidelines. Ethical approval has been obtained from the National Healthcare Group’s Domain Specific Review Board (reference number: 2022/00751). Results will be disseminated via publication in a relevant journal. Data will be available from the corresponding author on reasonable request.

Trial registration number

NCT06702293.

Exploring Work Experience, Job Satisfaction, Motivation and Intention to Stay Among Gig and Locum Nurses: A Mixed Methods Study

ABSTRACT

Aim

To examine temporary registered nurses' job satisfaction, motivation, intent to stay and work experiences of gig or locum nursing roles.

Design

A two-phase mixed methods study.

Methods

Participants were temporary registered nurses who engaged in gig or locum roles. In Phase I, a cross-sectional quantitative study was carried out to examine temporary nurses' job satisfaction, motivation and intent-to-stay. In Phase II, a descriptive qualitative study was conducted to provide a more nuanced understanding of the factors that influenced temporary nurses' work experiences. The participants took part in a one-time, individual, semi-structured audio- and video-recorded interview via Zoom. The interviews were transcribed verbatim and subjected to thematic analyses.

Results

A total of 111 temporary nurses were included in this study. The temporary nurses scored higher for the subscale on intrinsic job satisfaction than on extrinsic job satisfaction, with the lowest item score for career advancement. They scored highest for extrinsic motivation, with the highest item score on compensation. They also reported low intention to stay in their current roles. A purposive sampling of 20 nurses participated in the interviews. Four themes emerged from the qualitative findings on their work experience: flexible schedule for work-life balance, attractive yet unstable compensation, job autonomy and impeding clinical and professional growth.

Conclusion

Temporary nurses are attracted to gig or locum nursing work due to compensation, work flexibility and job autonomy. Further research to examine the perspectives of patients, permanent staff and nursing managers is needed to provide more insights for healthcare policymakers and administrators.

Impact

Healthcare organisation could consider incorporating flexible work schedule and job rotation to make permanent staffing models more attractive for them. The digital platform could be adopted to promote long-term engagement in specific work setting and foster career development, ensuring the safe practice of temporary nurses.

Patient or Public Contribution

No patient or public contribution.

Impostor syndrome, associated factors and impact on well-being across medical undergraduates and postgraduate medical professionals: a scoping review

Por: Chua · S. M. · Tan · I. Y. K. · Thummachai · M. E. · Chew · Q. H. · Sim · K.
Objectives

Impostor syndrome (IS) is a psychological state whereby individuals doubt their abilities despite evidence of competence. Though IS has been studied in specific medical groups, no review to date compares findings across groups. This study aimed to: (1) determine the range of IS rates among medical undergraduates versus postgraduates and (2) examine associated factors across both groups.

Design

This scoping review used the Joanna Briggs Institute methodology for scoping reviews, using a five-step framework.

Data sources

PubMed, Scopus and PsycINFO databases were searched from inception until September 2024.

Eligibility criteria

Studies were included if they were (1) empirical studies with a defined IS rating scale, (2) involving medical undergraduates, residents or clinicians and (3) published in English.

Data extraction and synthesis

Three independent reviewers used standardised methods to screen and review selected studies, and extract key variables.

Results

54 studies (77.8% from the West) were included. There was equal study distribution between undergraduates (46.3%, 25 studies) and postgraduates (46.3%, 25 studies), with the rest covering both groups. IS prevalence was substantial across all groups when assessed using the Clance Impostor Phenomenon Scale, ranging from 30.6% to 75.9% among undergraduates, 33.0% to 75.0% among residents and 23.5% to 50.0% among faculty and clinicians. In undergraduates, IS was associated with learning breaks, transition periods and poor academic performance. Among postgraduates, IS was correlated with younger age, junior ranking, fewer work years, inadequate faculty support or self-perceived poor clinical and teaching skills. Additionally, IS affected physical and psychological well-being (stress, anxiety, depression, burnout) and was associated with sociodemographic factors (single status, females), personality (neuroticism, perfectionistic traits, with conscientiousness, agreeableness and extraversion as protective) and interpersonal issues (conflicts, poor sense of belonging).

Conclusions

Given the high IS prevalence and associations with specific factors, practical measures are recommended to address IS and optimise learning and care for medical undergraduates and professionals.

Exploring Parents' Experiences and Perceptions of Caring for Children With Feeding Difficulties and Developmental Disabilities: A Descriptive Qualitative Study

ABSTRACT

Aim

To explore the experiences and perceptions of Singaporean parents in managing feeding difficulties among children with developmental disabilities.

Study Design

A descriptive qualitative study design was used.

Methods

Twenty parents were recruited via convenience sampling from a paediatric feeding clinic in a public hospital in Singapore between July and October 2024. One-to-one interviews were conducted using a semi-structured interview guide. Thematic analysis was used to analyse the data.

Results

Four themes were identified: (1) Feeding as a ‘guessing’ game; (2) mutual understanding within the family and community; (3) beliefs regarding developmental disabilities and feeding difficulties; and (4) challenges in accessing adequate support. There were a total of nine subthemes supporting these themes.

Conclusion

This study revealed that parents of children with developmental disabilities faced challenges in adjusting to their child's feeding preferences, dealing with conflicting views on feeding practices among caregivers, and accessing adequate support. Parents also valued instrumental support from grandparents and domestic helpers, as well as emotional support from online peers. Additional research and targeted interventions are needed to better support parents of children with developmental disabilities in managing feeding difficulties.

Implications

Policies should facilitate the provision of feeding-specific resources, treatment, and education for parents. Additionally, healthcare providers should proactively assess feeding-related concerns and address misconceptions to enhance parental awareness of feeding difficulties and how they can improve the feeding practices of their children with developmental disabilities. Future research should obtain a more in-depth understanding of how differing beliefs in feeding difficulties between parents can impact the child's developmental outcomes, as well as the support and resources that may address feeding needs in these children.

Reporting Method

This study followed the reporting guidelines outlined by the Consolidated criteria for Reporting Qualitative (COREQ) research checklist.

Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Cultural Adaptation and Validation of the Attitude Scale for Pressure Injury Prevention Among Clinical Nurses

ABSTRACT

To translate and validate psychometric analyses across different cultures. Pressure injuries are a concern in healthcare. Negative attitudes hamper prevention efforts, yet Taiwan lacks a reliable assessment tool. Translate the Pressure Injury Prevention Attitude Scale, originally developed by Moore and Price, into the Taiwanese version, verify the psychometric analysis, and evaluate clinical nurses' attitudes toward pressure injury prevention. Brislin's forward and backward translation, along with verification processes, were employed to ensure that the translated Taiwanese version is culturally and linguistically appropriate for Taiwan. Content validity was evaluated by a panel of seven experts specializing in pressure injury. Confirmatory factor analysis affirmed the validity of both positive and negative measures within the attitude scale items. A sample of 330 nurses from a regional teaching hospital participated in assessing the instrument's construct validity, internal consistency, and test–retest reliability. Data collection occurred between April and May 2021. The Attitudes Toward Pressure Injury Prevention—Taiwanese Version exhibited robust psychometric properties, demonstrating high item-level content validity and internal consistency as indicated by Cronbach's α. Additionally, it showed impressive test–retest reliability. Confirmatory factor analysis identified two distinct factors, reflecting positive and negative attitudes. The Attitudes Toward Pressure Injury Prevention Scale–Taiwanese Version effectively assesses nurses' attitudes towards PI prevention in Taiwan. It also informs future research on the relationship between attitudes, knowledge and clinical performance. The Attitudes Toward Pressure Injury Prevention—Taiwanese Version serves as a valuable tool for assessing nurses' attitudes in Taiwan, enhancing preventive measures and patient care. Managers and educators can utilize attitude measures on pressure injury prevention to shape training strategies.

Targeting osteosarcopenia and multimorbidity for frailty prevention through identification and deep phenotyping methods in healthy ageing and high-burden disease cohorts (OPTIMA-C): a longitudinal observational cohort study protocol for neuromusculoskelet

Por: Tay · M. R. J. · Kim · J. M. · Ong · P. L. · Khin · L. W. · Wong · C. J. · Kong · K. H. · Tan · B. Y. · Lee · E. S. · Sim · S. Z. · Lim · W. S. · Yam · M. G. J. · Chew · J. L. · Tan · A. W. K. · Sidarta · A. · Yee · E. · Chua · K. S. G.
Introduction

Sarcopenia and frailty have been identified as negative predictors of health outcomes. Patients with stroke, traumatic brain injury (TBI), knee osteoarthritis (OA) and breast cancer commonly experience low physical activity levels in the chronic phase of recovery. This prospective study aims to explore the feasibility of multimodal screening and longitudinal tracking of various biomarkers from the acute to chronic phase of disease to determine the relationship with frailty outcomes.

Methods and analysis

A prospective longitudinal observational cohort study involving Asian populations is planned over 3 years. Enrolled participants with index conditions of acute stroke, TBI, knee OA and breast cancer will be recruited from rehabilitation hospitals and clinics and followed longitudinally. Reference thresholds from the Asian Working Group on Sarcopenia will be used. Variables include self-reported questionnaires, disease and comorbidity characteristics, anthropometric measurements, appetite questionnaires, muscle ultrasound (MUS), muscle/bone mass, blood biomarkers and markerless gait motion systems. In particular, physical performance (short physical performance battery and hand grip strength), sarcopenia (SARC-F questionnaire) and frailty assessment (FRAIL score, clinical frailty scale), four-region MUS, body composition analysis, dual X-ray absorptiometry, bone mineral densitometry, physical activity levels (International Physical Activity Questionnaire for the elderly [IPAQ-E], fitness trackers) and health-related quality of life assessment (EuroQoL-5D questionnaire five level [EQ5D-5L]) will be used. Blood biomarkers measuring metabolic health (eg, glycated haemoglobin, cholesterol, fasting glucose and 25-OH vitamin D) and inflammation (eg, Tumor Necrosis Factor-alpha [TNF-α] and Monocyte Chemoattractant Protein-1 [MCP-1]) will be measured at baseline. Data collection will take place at postrecruitment baseline (hospital admission), 1, 6 months, 12 months and 2 years postrecruitment (inpatient) and at postrecruitment baseline, 6 months, 12 months and 2 years postrecruitment (outpatient).

Ethics and dissemination

Ethical approval has been obtained from the National Healthcare Group Domain Specific Review Board (2023/00105). Findings will be disseminated through conference presentations and publication in scientific journals.

Trial registeration number

NCT06073106.

Association between anthropometric factors and meningioma risk: A systematic review and meta-analysis

by Chao Xu, Chuan Shao, Jing Wang, Xinmin Ding, Nan Wu

Background

Data regarding the association between anthropometric factors and meningioma risk are inconsistent. Our aim was to investigate the association of body mass index (BMI), height, waist to hip ratio (WHR), waist circumference, and meningioma risk through a comprehensive meta-analysis.

Methods

An extensive review of literature was conducted in PubMed and Embase databases. Random-effects models were used to pool the study-specific relative risk estimates (RRs) and 95% confidence intervals (CIs). Moreover, we employed a dose-response meta-analysis with a one-stage robust error meta-regression (REMR) model.

Results

We included nine prospective studies for four anthropometric factors listed above and meningioma risk. Compared with normal weight, both overweight (RR:1.11, 95% CI: 1.04, 1.19; P = 0.003, I2 = 0.0%) and obesity (RR: 1.38, 95% CI:1.16, 1.64; P 2 = 54.7%) were statistically significantly associated with meningioma risk. Dose-response analysis showed a nonlinear relationship between BMI and meningioma risk (P = 0.038). For height, a positive association was identified for men (RR:1.30, 95% CI:1.08, 1.56; P = 0.005, I2 = 0.0%) but not women (RR:1.13, 95% CI: 0.94,1.36; P = 0.186, I2 = 49.8%). Highest vs. lowest levels analyses also showed a positive association between meningioma risk and waist circumference (RR:1.89, 95% CI:1.34, 2.66; P 2 = 0.0%) and WHR (RR:1.40, 95% CI:1.00, 1.94; P = 0.048, I2 = 0.0%).

Conclusion

Our meta-analysis indicates greater height (in men) and excess weight and body fat mass were associated with an increased risk of meningioma. Further prospective studies with particular attention to sex disparity and dose-response analysis are warranted to confirm our observation.

The Effect of an Integrative Cognitive Training Program by Family Caregivers on Cognitive Function Among Persons With Traumatic Brain Injury: A Randomized Controlled Trial

ABSTRACT

Purpose

This study aimed to examine the effect of an integrative cognitive training program by family caregivers on cognitive function among persons with traumatic brain injury.

Design

A randomized controlled trial, repeated measures design was utilized.

Methods

The participants were adult persons diagnosed with mild-to-moderate TBI and their family caregivers. They were recruited from the neurology ward at a tertiary hospital in Thailand. One hundred participants were randomly assigned to the experimental group (n = 50) and the control group (n = 50). The experimental group received an integrative cognitive training program from family caregivers based on the theory of neural plasticity in combination with a systematic review, while the control group received usual care. Cognitive function was assessed at baseline and week 2, week 4, and week 6 follow-up using the Montreal Cognitive Assessment. Data were analyzed using descriptive statistics, Chi-square, Fisher's exact test, and repeated measures ANOVA.

Findings

The results showed a significant improvement in cognitive function scores in the experimental group over time (p < 0.001). Additionally, participants in the experimental group who received an integrative cognitive training program by family caregivers demonstrated significantly higher cognitive function scores compared to the control group at week 4 and week 6 follow-up assessments (p < 0.001). The effect sizes were large (η 2 = 0.14) with a test power of 90%.

Conclusions

An integrative cognitive training program can enhance neuroplasticity and improve cognitive function among persons with mild-to-moderate traumatic brain injury. Moreover, involving family caregivers in the rehabilitation process can improve community engagement and cognitive abilities in persons with traumatic brain injury.

Clinical Relevance

Healthcare professionals in neurological settings should incorporate an integrative cognitive training program into their usual care and educate family caregivers to continue the intervention at home for improving cognitive function among persons with mild-to-moderate traumatic brain injury.

Trial Registration

TCTR20230828002

Development and Validation of a Nomogram Predictive Model and Scoring Tool for Assessing the Risk of Inadequate Bowel Preparation in Colonoscopy Patients Over 40 Years Old: A Retrospective Observational Study

ABSTRACT

Aims

To explore the potential risk factors contributing to inadequate bowel preparation in middle-aged and elderly patients (aged 40 and above) undergoing colonoscopy, and to subsequently devise and validate a comprehensive risk assessment tool and nomogram model for accurately predicting such preparation.

Design

A retrospective observational study was conducted at three campuses from January 2023 to December 2023.

Methods

Twenty-three clinical indicators derived from colonoscopy records were leveraged to inform the predictive models. By using multivariate and stepwise logistic regression analyses, a risk-scoring model and a nomogram prediction model were devised. Calibration curves were used to evaluate the model's accuracy, while decision curve analysis (DCA) and receiver operating characteristic (ROC) curves were used to evaluate the model's clinical applicability and discriminatory power, encompassing the Hosmer–Lemeshow χ2 test for goodness-of-fit. TRIPOD was used to guide this study.

Results

A total of 6860 outpatients who met the criteria were selected and divided into a training set (n = 4116) and a validation set (n = 2744) according to the bowel preparation quality. BMI, comorbidity, history of constipation, frailty degree, prescribing doctor's specialty, nonpatient's own prescribing, anxiety level and abdominal surgery history were independent risk factors for inadequate bowel preparation. The corresponding risk scores were 2, 0, 2, 4 3, 3, 2 and 1 respectively; with a total score of ≥ 8.5 classifying patients into a high-risk group. The area under the curve for the training and validation sets were 0.740 and 0.730, respectively, and an optimal critical value threshold of 34%. DCA findings demonstrated that the nomogram model was clinically helpful throughout a broad threshold probability range.

Conclusions

The risk prediction nomogram model and assessment tool constructed in this study can help clinicians identify individuals at high risk for inadequate bowel preparation at an early stage, which is a guideline for personalised prevention and treatment.

Trial and Protocol Registration

The name of the trial register was outpatient discharge management after general intravenous anaesthesia. The clinical trial registration was 2024–0116, and the link to the trial at the registration website was https://ctms.z2hospital.com:8443/.

Reporting Method

Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) checklist.

Patient or Public Contribution

Data for this study were provided by 7724 outpatients over 40 years old who underwent their first colonoscopy between January 2023 and December 2023 at three campuses of a medical centre.

Investigation of the Current Status of Core Competencies of ECMO Nurses in ICUs and Analysis of Influencing Factors: A Multicentre Survey

ABSTRACT

Background

ECMO techniques are commonly used to save critically ill patients with life-threatening conditions. The importance of ECMO nurses in the ECMO team and in caring for patients has been demonstrated, but the impact of the core competency dimension on ECMO nurses has not been explored. The level of core competence of ECMO nurses in the intensive care unit (ICU) is also influenced by mutiple factors. Moreover, the training of ECMO specialist nurses is closely related to the research of core competencies, and there are inconsistencies in training standards and diverse training contents in the exploratory stage, which still need to be improved.

Objectives

To understand the current status of core competencies of ECMO nurses in tertiary hospitals in mainland China and to provide a reference basis for revising the core competencies training programme for ECMO nurses.

Methods

A multicentre cross-sectional survey.

Results

A total of 307/322 (response rate: 95.3%) participants from ICUs of 16 tertiary hospitals in China took part in this study, and the total core competency score of ECMO nurses was (179.87 ± 46.22), with the highest-scoring dimension being personal attributes (3.87 ± 0.87) and the lowest-scoring dimension being professional development abilities (2.75 ± 0.96). The results of multiple linear regression analysis showed that gender, age, title, years of ICU experience, average number of ECMO patients per year in the department, number of ECMO trainings and whether or not they have participated in ECMO scenario simulation trainings are independent influences on the core competencies of ECMO nurses (all p < 0.05).

Conclusion

The level of core competence of ECMO nurses within ICUs in China needs to be improved, and nursing administrators should develop effective improvement measures to comprehensively enhance the overall level of core competence of ECMO nurses. The core competency level of ECMO nurses and its influencing factors were understood in this study, and the foundation for the construction of the core competency training program for ECMO nurses was laid. Management, training, and evaluation of ECMO nurses were informed by this study.

Implications for Clinical Practice

The core competency level of ECMO nurses was studied and analysed, which provided a reference for the management, training and evaluation of ECMO nurses in the ICU and the qualification criteria for ECMO specialist nurses. It is novel and clinically practical because it is innovative to evaluate the comprehensive competence of ECMO nurses in clinical practice from the perspective of the core competency framework. The influencing factors of the core competency level, combined with the research of relevant literature and qualitative interviews with ECMO nurses, have the opportunity to formulate training programmes and apply them to clinical practice, which reflects the meaningful relationship between this study and clinical practice.

We chose the STROBE Statement in the EQUATOR checklist for my study.

Effectiveness of Dyadic Interventions on Quality of Life for Cancer Patients and Family Caregivers: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials

ABSTRACT

Background

Increases in cancer survivorship negatively impact patients and family caregivers, decreasing quality of life. Previous dyadic interventions involved them as a unit and focused on their outcomes, but inconsistent results existed in influencing quality of life.

Objectives

To assess dyadic intervention effect on quality of life for cancer patients and family caregivers across different cancer types and intervention durations.

Design

A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Methods

Six databases were searched from establishment until 14 January 2024. Two authors independently performed the search process, literature screening, and data extraction. The ROB version 2 and GRADE were respectively used to check the methodology and evidence quality. The data were analysed via RStudio, and intervention effects were estimated with 95% CIs and SMDs. The statistical heterogeneity was explored through the I2 statistic, P values, and Egger's test, and differences in overall effects were deemed statistically significant, having a P value < 0.05. Subgroup analysis was also conducted.

Results

13 RCTs with 1625 participants, published from 2005 to 2021, were included. The results demonstrated that dyadic interventions enhanced quality of life for both cancer patients and family caregivers. Subgroup analysis suggested that family-centred interventions for patients with specific cancer types, which lasted for a long period (> 6 weeks), enhanced quality of life for cancer patients and family caregivers. The evidence and methodology were of a moderate quality.

Conclusions

Nurses are important practitioners of culture-oriented dyadic interventions. Long-term (> 6 weeks) and family-centred dyadic interventions for patients with a specific cancer type can enhance cancer patients' and family caregivers' quality of life, along with digital intelligence approaches to promote mutual communication and strengthen family relationships, thereby optimising oncology clinical nursing and enhancing the quality of life, health, and welfare of the entire family.

Relevance to Clinical Practice

Dyadic interventions emphasising the involvement of both cancer patients and family caregivers should be considered and tailored by professionals and oncology nurses to establish harmonious family relationships, improve family coping techniques and decision-making to enhance the whole family's quality of life and well-being according to their cultural contexts, and promote more efficient, targeted, and economical oncology care.

Patient or Public Contribution

No Patient or Public Contribution because all the involved participants were from existing studies, and the design, conduction, analysis, and interpretation of the data were completed by the authors in this article.

Trial Registration

International Prospective Register of Systematic Reviews: CRD42024519432; https://www.crd.york.ac.uk/PROSPERO/#recordDetails

The Empathy Level and Its Associated Factors Among Nursing Assistants in Long‐Term Care Facilities

ABSTRACT

Aim

This study aimed to investigate empathy levels among nursing assistants (NAs) in long-term care facilities (LTCFs) and identify factors associated with empathy levels.

Design

A cross-sectional national study.

Methods

We recruited 512 NAs from 232 LTCFs across Taiwan. Participants completed structured questionnaires including information on demographic characteristics and the Jefferson Scale of Empathy-Health Professions version (JSE-HP). The data were collected from April to July 2023.

Results

The average JSE-HP score among NAs was 101.46 ± 14.05. Empathy levels were significantly associated with several factors, including age, educational background, religious beliefs, economic status, length of work experience, and prior empathy training or courses. A multiple linear regression analysis identified age, educational level, economic status, and prior empathy training as significant predictors of empathy levels among NAs.

Conclusions

The findings of this study revealed that NAs in LTCFs in Taiwan exhibited low levels of empathy. NAs, who were older, had higher educational levels, had a better economic status, and had previous empathy training or courses demonstrated higher levels of empathy.

Impact

Empathy is vital in caregiving, and it is crucial to urgently address and enhance empathy among NAs. Future research should focus on developing targeted interventions to improve empathy levels of NAs within LTCFs.

Patient or Public Contribution

No patient or public contribution.

Struggles of Fatherhood: A Prospective Study on the Incidence of Paternal Postpartum Depression and Associated Factors

ABSTRACT

Aim

To investigate the incidence and the factors associated with paternal postpartum depression amongst new fathers in Singapore.

Design

A prospective repeated measures study was conducted from September 2023 to March 2024.

Methods

A total of 200 fathers aged 21 years and above who had a neonate born at full term and no serious health events for both mother and neonate were recruited from a local hospital via convenience sampling. Fathers completed questionnaires at the third trimester of pregnancy (baseline) and 1 month postpartum. Multiple regression analyses were used to identify significant factors associated with postpartum depression in fathers.

Results

The incidence of paternal postpartum depression was 5.26% at 1 month post-childbirth, using the Edinburgh Postpartum Depression Scale (EPDS). Using the Gotland Male Depression Scale (GMDS), 7% of the fathers were identified with high risk of depression and 14.3% of the fathers had moderate depressive symptoms. Paternal postpartum depression at 1 month post-childbirth could be predicted by paternal postpartum depression scores at baseline measured by EPDS and GMDS, as well as by baseline perceived social support and parental self-efficacy at 1 month post-childbirth.

Conclusion

This study found that a considerable number of fathers in Singapore are at risk of postpartum depression. There is an urgent need for the development of more comprehensive tools to measure postpartum depression in fathers that are culturally adapted to the local context.

Implications

Early screening during antenatal visits enables timely intervention and access to support, benefiting the entire family. Nurses could help fathers to be more involved by extending patient education and teaching infant care skills to both parents. When counselling patients, the involvement of extended family members and navigating new roles as caregivers of a new baby and breadwinners are important considerations for new parents.

Impact

This study is the first of its kind to measure the incidence of postpartum depression amongst new fathers in an urban multicultural Asian setting, like Singapore. The study found that the incidence of postpartum depression in fathers were 5.26% when measured using EPDS and 14.3% when measured using GMDS at 1 month postpartum. These findings could inform future family-centred and father-specific interventions to improve the mental health outcomes of new parents.

Reporting Method

This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Patient or Public Contribution

No patient or public contribution.

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